This information will help us provide financing on your new rig...
Please complete all fields.
 | Please identify yourself:
|
| Please provide the following contact information:
|
| Your Business Name Address Phone How Long in business | ||||||
| Credit Reference #1 Address Phone | ||||||
| Credit Reference #2 Address Phone | ||||||
| Your Bank
Address
Phone | ||||||
| Amount Requested
| ||||||
| Please provide the following product information:
|
Delivery of this application bearing a facsimile
signature(s) shall have the same force and effect as if the application bore an
inked original signature(s). The applicant certifies that all information
provided is true, correct and complete and that the account will be used solely
for business or commercial purposes. The applicant, owner(s) and guarantor (if
any) authorize Higgins Rig Co. or
its designee(s) or assignee(s) to obtain any information it may request from any
business or consumer reporting agencies or other sources that provide credit
reports, account history information, credit and employment history or similar
information; such authorization shall extend to update renewal of credit and for
reviewing or collecting the account. The applicant acknowledges that, based upon
such information and other factors which may apply,
Higgins Rig Co. or its assignee(s)
or designee(s), in their sole discretion, may either grant or decline to grant
credit.
By submitting this application, I also wish to continue to receive updates from
Higgins Rig Co. or its assignee(s)
or designee(s), regarding our account. Information should be sent to the fax
and/or email address given for the account.
I / We agree to the
above